Occupational epidemiological study of workers in an acrylonitrile using factory with particular attention to cancers and birth defects

An occupational epidemiological study was organised among workers in an acrylonitrile using factory in Hungary. Of the 888 workers, 783 were included in the study and three groups were differentiated: Group A (N = 452) with direct and continuous exposure, Group B (N = 171) with direct but occasional exposure and Group C (N = 160) without direct exposure, as referent. There were two main objectives: to determine the occurrence of cancer in workers and congenital abnormalities in their liveborn infants. The study did not indicate a higher occurrence of cancer among workers: only one lung cancer patient was found, prostate cancer did not occur. Among congenital abnormalities, the group of specified multiple congenital abnormalities showed a higher rate than expected but characteristic defect-pattern was not found among seven multimalformed babies, though five had cardiovascular malformations. In conclusion, our study did not indicate the carcinogenic, mutagenic and teratogenic effect of acrylonitrile among workers using this chemical in the factory.     

Aetiology of testicular cancer: association with congenital abnormalities,age at puberty,infertility, and exercise. United Kingdom Testicular Cancer Study Group.

OBJECTIVE--To determine the risk of testicular cancer associated with undescended testis, inguinal hernia, age at puberty, marital status, infertility, vasectomy, and amount of exercise. DESIGN--A population based case-control study with a questionnaire administered by an interviewer and with relevant supplementary data extracted from general practitioners'' notes. SETTING--Nine health regions within England and Wales. SUBJECTS--794 men, aged 15-49 years, with a testicular germ cell tumour diagnosed between 1 January 1984 and 1 January 1987; each had an age matched (within one year) control selected from the list of their general practitioner. RESULTS--There was a significant association of testicular cancer with undescended testis (odds ratio 3.82; 95% confidence interval 2.24 to 6.52) and inguinal hernia (1.91; 1.12 to 3.23). The excess risk associated with undescended testis was eliminated in men who had had an orchidopexy before the age of 10 years. There were positive associations with early age at voice breaking, early age at starting to shave, and infertility. There was a significant association with a sedentary lifestyle and a moderate protective effect of exercise. There was no association with vasectomy. CONCLUSION--This study confirms previous reports that developmental urogenital abnormalities result in an increased risk of testicular cancer. The trend to perform orchidopexy at younger ages may reduce the risk associated with undescended testis. The increased risks associated with early age at puberty and low amounts of exercise may be related to effects of exposure to endogenous hormones. Changes in both of these factors may partly contribute to the increasing rates of testicular cancer observed in the past few decades.     

Characteristics of cryptic/ectopic and contralateral scrotal testes in dogs between 1 and 2 years of age

Testicular malposition represents a common developmental genital defect in dogs and can affect one or both testes. In both humans and dogs, unilateral cryptorchism is more frequently detected and thought to be the expression of a genetic abnormality affecting both the undescended and scrotal testis. In the dog, there is evidence of degenerative processes affecting the maldescended testis. However, the histologic and functional changes that occur in the scrotal testis of unilateral cryptorchid or ectopic individuals remain a source of debate. Because the bilateral surgical removal of the testes leads to some undesirable side effects, the aim of this study was to evaluate the necessity for performing bilateral orchiectomy in young unilateral cryptorchid dogs. A morphologic study of both cryptic/ectopic and scrotal testes in young dogs affected by unilateral testicular maldescent was therefore conducted. The study was conducted on 10 dogs aged 1 to 2 yr and affected by unilateral testicular maldescent. We found that, in young dogs, even if no neoplastic lesions were observed, morphologic abnormalities are detectable between 1 and 2 yr of age in the maldescended testes with severity dependent on testicular position. In contrast, in the scrotal testes, the histologic and immunohistochemical exam failed to find signs of incorrect development or morphologic abnormalities. The results seem to suggest that, though the early removal of the undescended testis is recommended, continuous monitoring of the scrotal testis for the life of the dog is preferable to removing it considering the undesirable side effects related to castration.     

Risk of testicular cancer in cohort of boys with cryptorchidism.

OBJECTIVE: To determine the risk of testicular cancer in relation to undescended testis and its treatment based on recorded details of the maldescent, treatment, and biopsy from case notes. DESIGN: Cohort study. SETTING: Hospital for Sick Children, Great Ormond Street, London. SUBJECTS: 1075 boys with cryptorchidism treated by orchidopexy or hormones at the hospital during 1951-64. MAIN OUTCOME MEASURES: Relative risk of testicular cancer in the cohort compared with men in the general population. RESULTS: 12 testicular cancers occurred in 11 of the patients during follow up to mid-1990 (relative risk of cancer in males with cryptorchidism = 7.5 (95% confidence interval 3.9 to 12.8)). The relative risk fell significantly beyond 15 years after orchidopexy but did not decrease with younger age at orchidopexy. Risk was significantly raised in testes that had had biopsy samples removed during orchidopexy (relative risk = 66.7 (23.9 to 143.3) compared with a testis in a man in the general population) and was significantly greater in these testes than in undescended testes that had not had biopsy samples taken at orchidopexy (6.7 (2.7 to 13.5)). No reasons for biopsy or distinguishing clinical aspects of the testes that had had biopsy samples taken and later developed malignancies were evident in the case notes. No histological abnormalities were evident at initial biopsy except in one testis that had features of dysgenesis. CONCLUSIONS: Biopsy seems to be a stronger risk factor for testicular cancer than any factor previously identified. The trauma of open biopsy may contribute substantially to risk of malignancy or the testes may have been selected for biopsy on the basis of clinical factors predictive of malignancy but not mentioned in the case notes.     

Management of the undescended testis

Surgical correction of the undescended testis is frequently postponed beyond the optimal time, namely, 6 years of age.An accurate diagnosis of undescended testis may be made during the first year of life. Complications and mistakes arising from misdiagnosis of undescended testis and retracted testis may, therefore, be prevented by recording findings.The purpose of this article is to present the arguments in favour of early diagnosis and operative treatment of undescended testis, and to correct possible misconceptions.     

The epidemiology of cryptorchidism. John Radcliffe Hospital Cryptorchidism Research Group

A total of 3,559 boys were examined for cryptorchidism over a 2-year period. At birth, 5.9% (210/3,534) had one or both testes undescended and at 3 months of age 1.61% (57/3,534) still had an undescended testis. These figures represent an increase in undescended testis of 40% at birth and 68% at 3 months when compared with figures collected in a similar study in the late 1950s. This increase in cryptorchidism still does not account for the increased number of orchiopexies being performed. Low birthweight was also found to be a risk factor for the presence of an undescended testis.     

Maldescendus testis

Maldescendus testis is a common congenital abnormality occurring in 2-5% of full-term boys at birth in the Western countries. By 3 months of age, the incidence rate spontaneously reduces to 1-2% in this group. The etiology of the disorder is not known, but normal hypothalamo-pituitary-gonadal axis is usually a prerequisite for normal descent of the testes. Abnormal sexual differentiation is associated with maldescent. However, the majority of boys with maldescended testes show no endocrine abnormalities after birth. Several defects in developmental genes, such as homeobox genes and Insl3, have been described to cause cryptorchidism in mice, and disturbances in the regulation of these genes or their mutations may explain etiology of a large part of human testicular maldescent in the future. Increased degeneration of germ cells can be observed in undescended testes after the first year, and therefore early treatment is recommended. Surgical treatment is the most effective and reliable method to bring testes into the scrotum, but hormone treatment with either hCG or GnRH analogues can be considered, particularly in cases where testes can be palpated in high scrotal position. The efficacy of hormone treatment is less than 20% and depends on the initial location of the testis. Nonpalpable testes rarely descend with hormone treatment. Both surgery and hormone treatment can have untoward effects. Treatment with hCG has been associated with an inflammation-like reaction in the testes and an increased rate of apoptosis of germ cells leading to a reduced adult size of the testes. Vascular complications can occur during surgery, particularly in staged orchidopexies. Men with a history of undescended testis have an increased risk of testicular cancer. Impaired fertility is another long-term risk associated to maldescended testes. Fertility potential may be improved by early treatment. Although our knowledge on cryptorchidism has increased considerably during the last decades, many questions remain to be answered: Is the incidence rate increasing? What is causing maldescent? Do hormones have any role in the treatment?     

Intérêt de l’abaissement du testicule non descendu chez l’adulte. Etude à propos de 259 patients

Introduction

Undescended testis is a frequent congenital disease, more often diagnosed and treated during childhood. However, due to ignorance or negligence, this disease can be seen even after puberty, when it raises a therapeutic problem: is orchidopexy still useful? This study was designed to evaluate the outcome of orchidopexy at adulthood in terms of improvement of fertility and prevention of malignant degeneration.

Material and methods

Retrospective study performed over a 23-year period (1983–2005). We have found 259 patients with undescended testis diagnosed and treated after the age of 18 years.

Results

The mean age of patients was 24 years (range: 18–63). In the majority of cases, undescended testis was diagnosed at a systemic medical examination in 199 patients (77% of cases), and in a context of infertility in 33 patients, testicular malignancy in 8 patients, testicular torsion in 2 patients and, in 17 cases, undescended testis had been known since birth but was neglected by the parents. Undescended testis was unilateral in 209 cases and bilateral in 50 cases. Out of 37 couples, only 4 gave birth to children (10.8% paternity rate). Sperm analysis was abnormal in all infertile patients. All patients were treated by orchidopexy, except for 36 patients in whom orchidectomy was performed due to testicular atrophy (27 cases), malignancy (8 cases) or necrosis (1 case). Biopsy of the intrascrotal testis was performed in 3 patients with unilateral cryptorchidism. Histological examination was normal in two cases and abnormal in one case. The long-term outcome was characterized by:

1. Testicular atrophy in 6 patients (2.7% of cases).
2. Progression to malignancy in 3 patients (1.3% of cases).
3. Improvement of sperm parameters in 16 of 33 infertile patients (48.5%); 4 patients fathered children after treatment.

Conclusion

Orchidopexy at adulthood can lead to improvement of infertility. It can also decrease the incidence of malignancy and facilitate clinical examination looking for possible malignancy. However, the best treatment remains preventive, based on early diagnosis and orchidopexy.     

Sarco(endo)plasmic reticulum and plasmalemmal Ca(2+)-ATPase activities in cremaster muscles and sacs differ according to the associated inguinal pathology

Sarco(endo)plasmic reticulum Ca(2+)-ATPase (SERCA) and plasmalemmal Ca(2+)-ATPase (PMCA) activities in cremaster muscles and sacs, which have been subjected to different autonomic tonuses, were determined and compared. Samples of cremaster muscles and sacs associated with male or female inguinal hernia, hydrocele or undescended testis were obtained from children during operations and activities of SERCA and PMCA were determined. While highest SERCA and PMCA activities were encountered among cremaster muscles and sacs associated with undescended testis, least activities were encountered among structures associated with hydrocele. The alterations in SERCA and PMCA activities in cremaster muscles associated with undescended testis appear to reflect the attempts at maintaining the levels of cytosolic calcium. Despite similar total calcium contents, lower SERCA and PMCA activities were found in sacs associated with hydrocele compared to those associated with undescended testis suggest a difference among the levels of cytosolic calcium.     

气候变化背景下中国农业气候资源变化Ⅶ.青藏高原干旱半干旱区农业气候资源变化特征

基于青藏高原干旱半干旱区1961-2007年55个气象站点地面观测资料,利用五日滑动平均法及GIS软件的IDW模块进行栅格处理,对比分析了研究区1961-1980年（时段Ⅰ）和1981-2007年（时段Ⅱ）各气候要素的时空变化特征及其气候倾向率.结果表明：1961-2007年,研究区喜凉作物生长季内日照时数的变化不明显,喜温作物生长季内日照时数呈增加趋势,但空间分布的变化较小;与时段Ⅰ相比,时段Ⅱ喜温作物生长季内积温值≥1500 ℃·d的地区面积扩大33.9%;降水量的空间分布总体表现为由东南低地向西北内陆逐渐递减,研究期间青藏高原东南部喜凉作物生长季内降水量均达到800 mm,其他地区喜凉作物生长季内降水量的气候倾向率有正有负,变幅相对较小,与时段Ⅰ相比,时段Ⅱ喜温作物生长季内降水量≥400 mm的分布面积扩大了40%;参考作物蒸散量（ET₀）总体略有增加,其空间分布格局与日照时数和积温的分布相似,时段Ⅱ较时段Ⅰ喜温作物生长季内ET₀≥400 mm的分布面积扩大了35.7%.研究期间,青藏高原作物生长季内的热量与降水资源有一定幅度增加,这对农牧业生产非常有利,但ET₀的增大表明潜在蒸发增大,需进一步加强研究气候变化对该区域农牧业生产带来的可能影响.     

The treatment of cryptorchidism

Medical opinion is quite confused about the age for and the method of treatment of the undescended organ. Histologic studies reveal that the spermatogenic cells of the undescended testis show definite injury by the age of four or five years. It therefore seems necessary to see that the testis is in the bottom of the scrotum before that age. Chorionic gonadotropins or testosterone should be tried first. If medical treatment fails, orchidopexy should be done without delay.     

Maternal severe migraine and risk of congenital limb deficiencies

BACKGROUND: Migraines occurs frequently during pregnancy; however, there are no published data on their possible teratogenic potential in a controlled epidemiological study. Therefore, we examined the risk of congenital abnormalities in infants born to women who had migraines and other headaches during pregnancy. METHODS: Between 1980 and 1996, the Hungarian Case-Control Surveillance of Congenital Abnormalities evaluated 22,843 cases (newborns or fetuses) with congenital abnormalities, 38,151 control newborn infants without any abnormalities, and 834 malformed controls with Down syndrome. RESULTS: Migraines anytime during pregnancy occurred in 565 (2.5%) mothers of the case group compared with 713 (1.9%) mothers in the control group (crude prevalence odds ratio [POR], 1.3; 95% confidence interval [CI], 1.2-1.5) and 24 (2.9%) pregnant women in the malformed control group (crude POR, 0.9; 95% CI, 0.6-1.3) The mothers of 247 cases, 533 controls, and 21 malformed controls had severe migraines during the second and/or third months of pregnancy. There was only 1 congenital abnormality group: limb deficiencies, which had a higher rate of maternal migraines during the second and third months of pregnancy both at the comparison of cases and matched controls (adjusted POR, 2.5; 95% CI, 1.1-5.8) and of cases and malformed controls (adjusted POR, 1.7; 95% CI, 1.3-3.0). There was no association between other headaches and different congenital abnormalities at the comparison of cases and controls. CONCLUSIONS: Our data showed that maternal severe migraines during the second and/or third months of pregnancy were associated with an increased risk of congenital limb deficiencies. A similar association was not detected between congenital anomalies and other headaches during pregnancy. Our study was not based on a prior hypothesis; therefore, these data can be considered only as a signal that needs confirmation by independent data sets.     

Dandy-Walker malformations in a case of partial trisomy 9p (p12.1→pter) due to maternal translocation t(9;12)(p12.1;p13.3)

We describe a five-year-old proband presented with Dandy-Walker malformations, right microopthalmia, hamstring contractures, undescended testis with absence of testis in right scrotum in addition to typical trisomy 9p clinical features. Routine cytogenetic studies with GTG - banding showed 46,XY,der(12)t(9;12) (p12;q13.3),mat karyotype (trisomy 9p). Chromosomal analysis of the father was normal and phenotypically normal mother had 46,XX,t(9;12)(p12;q13) karyotype. Fluorescence in situ hybridization analysis with single copy probes bA5OIA2 (9p11.2), bA562M8 (12p12.1) and centromere probes (9) showed break point at 9p12.1 region. The gene dosage effect of Chromosome 9p along with environmental factors might be associated with Dandy- Walker malformations in the patient.     

Morphological findings in cryptorchism in the adult male

Cryptorchidism, the most common endocrine disturbance in the newborn, is still present in 0.3% of all postpubertal men as monolateral or bilateral condition. The undescended testis, in postpubertal age, is permanently damaged, so about 80% of cryptorchids are subfertile or definitively sterile. In the present study we relate our observations on structure and ultrastructure of testicular biopsies obtained from 29 cryptorchid men aged from 16 to 64. The individual pattern of morphological alterations is closely related to age and position of undescended testis. The following aspects are recognizable in cryptorchid testis: 1) seminiferous tubules reduced in size and irregular in shape; 2) tubular lumen occluded; 3) reduced germ cell population; 4) altered stages of spermatogenesis; 5) increased thickness of spermatogonia layer; 6) vacuolization of germ cells; 7) polynucleated germ cells; 8) acrosomal deformities; 9) delivery of immature germ cells; 10) Sertolisation of the seminiferous tubule; 11) immature Sertoli cells; 12) multilayered and thickened basement lamina; 13) peritubular fibrosis; 14) vascular fibrosis; 15) vacuolisation of Leydig cells; 16) interstitial mastocytosis. The findings present a mosaic of the morphological events, that are characteristic not only of the undescended testis but also of numerous testicular pathologies as well as of other conditions as prolonged hyperthermia, experimental ischaemia and senescence.     

Changing patterns of teenage pregnancy: population based study of small areas

ObjectivesTo measure the impact of socioeconomic deprivation on rates of teenage pregnancy and the extent of local variation in pregnancy rates in Scotland, and to examine how both have changed over time.Design Population study using routine data from hospital records, aggregated for small areas.Subjects Female teenagers resident in Scotland who were treated for pregnancy in an NHS hospital in either 1981-5 (62 338 teenagers) or 1991-5 (48 514) and who were aged 13-19 at the time of conception.Results From the 1980s to the 1990s pregnancy rates increased differentially according to levels of local deprivation, as measured by the Carstairs index. Among teenagers aged less than 18 the annual pregnancy rate increased in the most deprived areas (from 7.0 to 12.5 pregnancies per 1000 13-15 year olds and from 67.6 to 84.6 per 1000 16-17 year olds), but there was no change, on average, among teenagers in the most affluent areas (3.8 per 1000 13-15 year olds and 28.9 per 1000 16-17 year olds). Among 18-19 year olds the pregnancy rate decreased in the most affluent areas (from 60.0 to 46.3 per 1000) and increased in the most deprived areas (from 112.4 to 116.0 per 1000). The amount of local variation explained by deprivation more than doubled from the 1980s to the 1990s. The proportion of pregnancies resulting in a maternity was positively associated with level of deprivation, but the effect remained similar over time.Conclusion From the 1980s to the 1990s the difference in rates of teenage pregnancy between more affluent and more deprived areas widened. This has implications for allocating resources to achieve government targets and points to important social processes behind the general increase in the number of teenage pregnancies in Scotland.

What is already known on this topic

Rates of teenage pregnancy are considerably higher in the United Kingdom than in other western European countriesIn the United Kingdom rates of teenage pregnancy are known to be higher in areas of greater socioeconomic deprivation, although local variation may also reflect differential access to family planning services

What this study adds

From 1981-5 to 1991-5 rates of teenage pregnancy in Scotland increased more rapidly in areas of greater socioeconomic deprivationIn the 1990s socioeconomic deprivation explained more than 50% of local variation in rates of teenage pregnancy, more than double the amount explained by it in the 1980s     

Pasture Characteristics in Three Different Ecotypes at Khovd Aimag,Western Mongolia

The transition of nomadic pastoralism to more sessile forms of rangeland utilization and increased stocking rates can result in the degradation of pasture. After political changes in the 1990s in Mongolia, population growth and missing alternative livelihoods intensified the grazing pressure on pastures, and further decreased the condition of the fragile arid ecosystems. To learn more about the productivity and quality of pasture land in Khovd Aimag in the western region of Mongolia, standing biomass was measured in the alpine region, mountain steppe and semi-desert. Plant samples were analyzed for nitrogen and fiber contents by wet chemistry and Near Infrared Spectroscopy (NIRS). Results show clear differences in distribution of biomass with reduced biomass in the vicinity of temporary settlements. From July to early September plant nitrogen contents decreased in the alpine region, remained unchanged in the mountain steppe and increased in the semi-desert. Nitrogen concentrations were elevated in vegetation close to temporary settlements. For fiber contents (ADF) no clear patterns were found. Neither biomass/m² nor vegetation cover were appropriate indicators for food quality.     

Abnormal germ cell development in cryptorchidism.

BACKGROUND: Previous studies suggest that two fundamental, probably androgen-dependent, steps in maturation of germ cells normally occur in the prepubertal testis: the disappearance of gonocytes (the fetal stem cell pool) and the appearance of adult dark spermatogonia (the adult stem cell pool) at 2-3 months of age and the appearance of primary spermatocytes (the onset of meiosis) at 4-5 years. Previous studies of small series of cryptorchid boys suggest that both steps are defective in undescended testes and to a lesser degree in descended testes contralateral to unilaterally undescended testes. The purpose of this study is to confirm the previous findings of defective germ cell maturation in a large series of boys with unilateral undescended testes. PATIENTS: Seven hundred and sixty-seven boys with unilateral cryptorchidism who had orchidopexy and bilateral testicular biopsies between birth and 9 years of age were studied. MATERIALS AND METHODS: Total and differential germ cell counts were performed on semithin histologic sections of the biopsies. The results from the undescended and contralateral descended testes were compared using the Wilcoxon signed-rank test and the Wilcoxon-Whitney-Mann U test. RESULTS: Gonocytes failed to disappear and adult dark spermatogonia failed to appear in undescended testes under 1 year of age indicating a defect in the first step in maturation at 2-3 months resulting in failure to establish an adequate adult stem cell pool. Primary spermatocytes failed to appear in undescended testes and appeared in only 19% of contralateral descended testes at 4-5 years of age indicating a defect in the onset of meiosis. CONCLUSION: Unilaterally undescended testes fail to establish an adequate adult stem cell pool which normally occurs at 2-3 months of age and fail to establish adequate meiosis which normally occurs at 4-5 years of age. Similar but less severe changes are seen in the contralateral descended testes. Defects in the two pubertal steps in germ cell maturation are associated with reduced total germ cell counts.     

西南地区农业洪涝等级指标构建及时空分布特征

利用西南农业区341个气象站1961—2010年的逐日降水量资料,结合灰色关联分析,以重庆市单站洪涝指标为原型,对该指标降水量临界值进行幅度为-50～+50 mm、步长为1 mm的增减,得到该区域各省份相对应的101个洪涝指标,并结合基于各洪涝指标计算得出的洪涝发生强度与农作物洪涝实际受灾程度的相关性、指标与历史洪涝灾害记录的吻合性以及分省指标的可比性,确定了各省农业洪涝等级指标,同时,分析了该区域农业洪涝灾害的时空分布特征.结果表明： 构建的云南指标为原指标+16 mm,贵州指标为原指标+30 mm,四川-重庆指标为原指标+40 mm,指标定义的洪涝指数与各省份受灾率的相关系数分别为0.314（P<0.05）、0.553（P<0.01）和0.305（P<0.05）,指标与历史灾害记录的吻合性较高.1961—2010年,云南、贵州、四川-重庆洪涝发生较严重的年代分别为20世纪80年代、20世纪90年代、20世纪80年代和21世纪初,洪涝多发区分别位于云南西南和东南部、贵州西南部和四川盆地的西部和东北部.     

Cancer risk in mothers of men operated for undescended testis

Background

Undescended testis, or cryptorchidism, occurs in 2–5% of boys born at term, and by 12 months of age about 1% of all boys have manifest cryptorchidism. Several hormonal substances control this process and disruption of the foetal sex-hormones balance is a potential cause of undescended testis, however, to a great extent the aetiology of cryptorchidism is unclear.

Methodology

To study risk factors involved in the aetiology of undescended testis, we assessed cancer risk in 15,885 mothers of men operated for undescended testis in Sweden. Women were followed-up for a median period of 23 years during which 811 first primary malignancies occurred. Their cancer incidence was compared with that in the general population estimating standardized incidence ratio (SIR) and corresponding 95% confidence interval (CI).

Principal Findings

The overall cancer risk experienced by the mothers of cryptorchid men did not differ significantly from that of the general population (SIR = 0.94; 95% C.I. = 0.88–1.01). Specifically, there was a reduction in ovarian cancer risk (SIR = 0.72; 95% C.I. = 0.51–0.99), while the risk of lung (SIR = 1.38 95% C.I. 1.03–1.81) and biliary tract/liver cancer (SIR: 1.76, 95% CI: 1.03–2.82) were increased.

Conclusions

Although we cannot rule out the role of chance, our data suggest a positive association between undescended testis and maternal lung cancer and a negative association with ovarian cancer, where the first may be partly attributable to smoking and the second to an altered hormonal milieu during pregnancy and thus both exposures may be risk factors for cryptorchidism.     

Higher mortality in deprived areas: community or personal disadvantage?

OBJECTIVE--To investigate the association between level of social deprivation in electoral wards and premature mortality among residents, before and after allowing for levels of personal deprivation. DESIGN--Longitudinal study of the Office of Population Censuses and Surveys. SETTING--England. SUBJECTS--Random sample of nearly 300,000 people aged between 16 and 65 at the 1981 census and followed up for nearly nine years. MAIN OUTCOME MEASURE--Death from all causes between ages of 16 and 70. RESULTS--Without allowance for personal disadvantage, both sexes showed a clear, significant, and roughly linear positive relation between degree of deprivation of the ward of residence in 1981 and premature death before 1990. For men, this association was effectively explained away once allowance was made for individual socioeconomic circumstances. For women living in wards of above average deprivation, the association was also effectively removed, but the situation for other women was less clear. CONCLUSION--The excess mortality associated with residence in areas designated as deprived by census based indicators is wholly explained by the concentration in those areas of people with adverse personal or household socioeconomic factors. Health policy needs to target people as well as places.